pragmatic trials
oracknows | November 4, 2016That I’m not a fan of the National Center for Complementary and Integrative Health (NCCIH, formerly known as the National Center for Complementary and Alternative Medicine, or NCCAM) should come as no surprise to anyone. Basically, from its very inception as the Office of Alternative Medicine in the early 1990s to its growth to large center with a yearly budget of $120+ million, NCCIH has served one purpose: The promotion and attempted legitimization of quackery and magical thinking in medicine, the better to “integrate” pseudoscientific medicine with science-based medicine. Certainly, the…
oracknows | January 16, 2014Practitioners of "complementary and alternative medicine" (CAM) have a love-hate relationship with randomized clinical trials (RCTs). Actually, it's mostly hate, but they do crave the validation that only randomized clinical trials can provide within the paradigm of evidence-based medicine (EBM). Yes, I intentionally said EBM, rather than science-based medicine (SBM), because, as I've described so many times before, the two are not the same thing. EBM fetishizes clinical trials, a fixation that I sometimes call "methodolatry," defined by a blog bud of mine from long ago as the "profane…
oracknows | May 13, 2013I'm not alone in pointing this out, but if there's one thing about research and clinical trials into "complementary and alternative medicine" (CAM) that has become very apparent to me over the years, it's that the more rigorous the study the less likely it is to show an effect. In normal research, the usual progression in clinical research goes from small pilot and observational studies to small to medium-sized randomized studies, ultimately culminating in large randomized, double-blind studies that are tightly controlled to eliminate as many potential biases and confounders as possible, as…